Stagnant Physician Reimbursement as Hospital Reimbursement Increases for Inpatient Total Knee Arthroplasty in...

As inflation, new technology, and rising costs continue to strain health care in the United States, it is important to understand the trends in insurance reimbursement. We evaluated commercial insurance reimbursement for patients undergoing inpatient primary total knee arthroplasty (TKA) based on the technology utilized and over time. We retrospectively reviewed a commercial claims database for 33,157 inpatient primary TKAs performed with cemented or uncemented components between January 1, 2016 and December 31, 2021. All patients had private commercial insurance and procedure codes for both the hospital and physician were present. Records were reviewed for technology used and financial reimbursement, without adjusting for inflation. Independent-samples t-test and analysis of variance were performed. Hospital reimbursement increased from $25,207.65 per TKA in 2016 to $28,291.10 in 2021 (p < 0.001). Physician reimbursement remained similar, from $2,368.25 per TKA in 2016 to $2,279.70 in 2021 (p = 0.1). Cemented TKA was associated with increased hospital reimbursement compared with uncemented TKA ($26,658.98 vs. $25,854.92, p < 0.001), but similar physician reimbursement ($2,358.03 vs. $2,329.60, p = 0.6). Robotic-assisted (RA) cemented TKA had the higher hospital reimbursement ($28,910.19) than manual cemented TKA ($26,342.29), manual uncemented ($25,566.31), and RA uncemented ($26,378.05, p < 0.001). Physician reimbursement was similar in each of the four categories: manual cemented ($2,359.34), manual uncemented ($2,282.62), RA cemented ($2,348.66), and RA uncemented ($2,414.75, p = 0.5). Physician reimbursement has remained similar for primary TKA from 2016 to 2021, despite hospital reimbursement increasing. We believe that physician reimbursement should increase each year to reflect the increased cost of living caused by inflation. In addition, RA cemented primary TKA provides the highest reimbursement for both hospitals, but physicians are reimbursed similarly, independent of the technology used.